Key result
Carotid artery stenting in a real-world registry demonstrated an 8.7% rate of the primary composite outcome of periprocedural MACCE and long-term ipsilateral stroke over a median follow-up of 80.5 months.
Why the study?
Despite randomized controlled trials comparing CAS and CEA for carotid artery stenosis, real-world data outside the rigorous environment of trials remains scarce.
Observational (n=115)
No
Real-world registry data demonstrates that carotid artery stenting is a safe and effective long-term intervention for patients with significant carotid artery stenosis, with low rates of periprocedural MACCE and long-term stroke.
Supports long-term carotid stenting outcomes in registries; leaves open randomized comparisons to endarterectomy or medical therapy.
Background Carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy (CEA) for the prevention of future cerebrovascular events in patients with carotid artery stenosis. Despite multiple randomized controlled trials (RCTs) comparing CAS and CEA for carotid disease, real-world data outside the rigorous environment of trials is scarce. Methods The present study is a prospective observational study conducted at a tertiary care center, wherein all patients who underwent CAS between January 2007 and December 2019 were included. All patients were followed up for one year of the last enrolled patient at an interval of one, six, and 12 months and then yearly thereafter. The primary composite outcome was defined as a combination of periprocedural (until 30 days of procedure) major adverse cardiac and cerebrovascular events (MACCEs) and the long-term incidence of ipsilateral stroke. The secondary outcome included the rate of restenosis. Results A total of 115 patients (86 males and 29 females) (147 lesions) who underwent CAS between 2007 and 2019 were followed up for a median of 80.5 months. Seventy-seven (67.27%) patients were symptomatic, and 38/115 (33%) were asymptomatic. Periprocedural MACCEs were noted in six patients, and four patients had ipsilateral stroke on long-term follow-up; hence, the primary composite outcome was observed in 10 (8.7%) patients. Higher age was found to be significantly associated with the primary composite outcome (p-value = 0.005). Five (4.34%) patients were lost to follow-up, while four (3.48%) patients developed restenosis. Conclusion CAS is a safe and less invasive intervention in patients with significant carotid artery stenosis and is equally effective in preventing future strokes. The incidence of primary outcome rises with an increase in age.
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Kumar et al. (2022) conducted an observational in Carotid artery stenosis (n=115). Carotid artery stenting (CAS) was evaluated on Composite of periprocedural (until 30 days) major adverse cardiac and cerebrovascular events (MACCEs) and long-term incidence of ipsilateral stroke. Carotid artery stenting in a real-world registry demonstrated an 8.7% rate of the primary composite outcome of periprocedural MACCE and long-term ipsilateral stroke over a median follow-up of 80.5 months.
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